Korean J Nephrol.  2000 Sep;19(5):918-925.

Recurrent Focal Segmental Glomerulosclerosis Following Renal Transplantation: Natural Course and Treatment with Plasmapheresis

• Lee KT
• Park KD
• Hwang EA
• Park SB
• Kim HC
• Park KK

Abstract

The recurrence of focal segmental glomerulosclerosis(FSGS) after renal transplantation has a potentially deteriorating course toward the loss of graft function. To identify risk factors for recurrence and efficacy of plasmapheresis, we evaluated outcome of 20 renal allografts in 18 patients with FSGS who underwent transplantation from March 1992 to September 1999. Recurrence was observed in seven of 18(39%) patients. Patients who had rapid progression to end stage renal disease, young age at the time of onset of the disease and the presence of mesangial proliferation tended to more frequent recurrence, albeit statistically not significant. Five patients underwent plasmapheresis. Proteinuria decreased from 5.3+/-2.1g to 0.8+/-0.7g immediately after completion of plasmapheresis. Four patients with an improvement in proteinuria had stable renal function at last follow-up. One patient who had chronic rejection lost graft function at 22 months after renal transplantation. In one in whom plasmapheresis was initiated immediately without allograft biopsy had long-lasting complete remission. Two patients who not receive plasmaApheresis, lost their graft funtion at 21 and 97 months after renal transplantation. We concluded that plasmapheresis in likely to be effective in the therapy of recurrent FSGS if the diagnosis is made promptly following the appearance of proteinuria, there is no significant hyalinosis on preplasmapheresis biopy and plasmapheresis is initiated immediately.

Keyword

Recurrent focal segmental glomerulosclerosis; Plasmapheresis; Renal transplantation

MeSH Terms

Allografts
Biopsy
Diagnosis
Follow-Up Studies
Glomerulosclerosis, Focal Segmental*
Humans
Kidney Failure, Chronic
Kidney Transplantation*
Plasmapheresis*
Proteinuria
Recurrence
Risk Factors
Transplants